Rules to Live By: Senior Assisted Living Program Regulation Requirements

The state of Maryland has a long list of regulations that assisted living facilities are supposed to comply with. These regulations are contained in the Maryland Code of Regulations (COMAR 10.07.14). Whether a regulation is complied with varies from facility to facility, with some trying their best while others intentionally break them or look the other way if the rules aren’t met.

It’s up to the state Department of Health and Mental Hygiene and the Office of Health Care Quality (OHCQ) to enforce the regulations. Violations can result in a fine, suspension or revocation of the facility’s license to operate; and if an entity is operating an assisted living facility without a license, it’s a felony criminal offense. If there’s a case of neglect or abuse of a resident, the fact that a regulation was broken or ignored may help a family show that the facility’s management is responsible for the injury or death of a resident.

Maryland assisted living facility regulations cover many aspects of the operations of such a facility — from licensing to staff qualifications, water supplies, smoking, furniture and sewage disposal. Some of the regulations that more directly impact possible neglect and abuse of residents include these:

An assisted living facility can provide different levels of care for residents: low, moderate and high. An issue with assisted living facilities is that, in order to generate revenue, they may accept as a resident someone whose needs are more than they can handle. Sometimes, if the person’s condition declines, they won’t discharge the resident to more appropriate care so that they will continue getting payments for the person’s care.

The facility and its records must be open to a department inspection at any time, whether that inspection is known ahead of time or not. If a facility is found to have violated regulations, it is issued a notice of the violation or deficiency which the facility must provide a plan of correction.

An assisted living facility is required by state regulation to have a sufficient number of staff to care for residents and these employees must be qualified to do their jobs. Due to increasing costs, increasing numbers of residents, high employee turnover (often due to low pay and/or poor working conditions) and not enough good job applicants, many assisted living facilities fall short on staffing and qualifications. Facilities can be so short-staffed that insufficient care can become the norm, medical records are falsified to indicate residents were cared for when they actually were not, and over-worked staff can lash out at residents who may be chemically or physically restrained to make it easier for fewer staff to supervise more residents.

Medications are supposed to be properly managed and administered. This often doesn’t happen. Medication mistakes are common: the wrong medications are given to residents, or the right medication is given but in the wrong dose. In extreme cases, residents can be chemically restrained by being intentionally over-medicated in order to make them more compliant, or even semi-conscious, so they’re easier to care for.

A state regulation requires an assisted living facility to develop and implement policies and procedures prohibiting abuse, neglect and financial exploitation of residents; they must not knowingly hire someone with a criminal conviction or other criminal history that shows behavior that may be harmful to residents; and a licensee or employee who has witnessed or who has reason to believe a resident has been abused, neglected or suffered financial exploitation is required to report the incident within 24 hours to an appropriate government agency. While this legal obligation exists on the books, it’s only as good as the willingness of staff and management to comply with it — and the forcefulness of the state in enforcing it.

Most cases involving neglect and abuse by assisted living facilities and their staff are negligence actions. Key parts of such a lawsuit are establishing that there was a legal duty of care to the resident by the facility or its employees and that the duty of care was violated. Maryland’s regulations create duties of care for potential defendants, and the facts of a case can be used to show those duties were violated.

If you have observed, or even suspect, nursing home neglect or abuse of a loved one in a Maryland assisted living facility in violation of these regulations, call 1-866-529-5839 to begin an investigation that may result in compensation for injuries suffered and the responsible parties’ being held accountable.

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